血清CRP、LDH水平及贫血与难治性或复发性非霍奇金淋巴瘤预后关系的探讨

目的探讨血清C反应蛋白(CRP)、乳酸脱氢酶(LDH)水平及贫血与难治性或复发性非霍奇金淋巴瘤(NHL)患者预后的关系。方法将血清CRP、LDH、血红蛋白(Hb)等因素纳入单因素分析和多因素Cox比例风险模型进行回归分析,以确定其是否为60例NHL患者预后的独立危险因素,分析LAC指数、不同挽救治疗方案对难治性或复发性NHL患者生存情况的影响。结果多因素Cox比例风险模型分析结果显示,血清CRP水平异常升高、血清LDH水平异常升高、处于贫血状态、采取挽救治疗方案DH AP/DH AP+R是难治性或复发性NHL患者生存的独立危险因素(P<0.05)。Log-rank检验结果显示,血清CRP水平正常与异常升高、LDH水平正常与异常升高、Hb水平正常与贫血患者的生存情况比较,差异均有统计学意义(P<0.05)。60例难治性或复发性NHL患者中,高危组患者32例,低危组患者28例,两组生存情况比较,差异有统计学意义(P<0.01)。Cox比例风险模型回归分析结果显示,LAC指数是难治性或复发性NHL患者预后的高危因素(P<0.01)。低危组患者对治疗的总体反应率和完全缓解率均明显高于高危组(P<0.01)。不同挽救治疗方案难治性或复发性NHL患者的生存情况比较,差异有统计学意义(P<0.05)。结论经挽救治疗后,血清CRP、LDH水平较高及处于贫血状态提示复发或难治性NHL患者预后不良。

The prognostic value of serum CRP,LDH and anemia for refractory and relapsed non-Hodgkin lymphoma

Objective To investigate the relationship of serum C-reactive protein(CRP)and lactate dehydrogenase(LDH)and anemia with the prognosis of with refractory and relapsed non-Hodgkin lymphoma(NHL).Method Serum CRP,LDH,hemoglobin(Hb)and other risk factors were included in the univariate or multivariate Cox proportional hazard model for regression analysis to determine if they act as independent risk factors for the prognosis of NHL patients.The effect of LAC index and rescue therapies on the survival of refractory and relapsed NHL patients were analyzed.Result Multivariate Cox proportional risk model analysis showed that,abnormal elevation of serum CRP and LDH,presence of anemia and administration of rescue therapies with DHAP/DHAP+R were independent risk factors affecting the survival of patients,which were of statistical significance(P<0.05).Log-rank test indicated that the survival rates of patients with normal level or abnormal elevation of serum CRP,normal or elevated LDH,normal Hb and positive anemia were significantly different(P<0.05).Among the 60 cases with refractory or relapsed NHL,32 were with high-risk disease while 28 had relatively low-risk lesions,the survival in the two subgroups demonstrated significant differences(P<0.01).Cox proportional hazard model regression was performed and suggested that LAC index was the high-risk prognostic factor for refractory or relapsed NHL patients(P<0.01).Besides,the overall response rate and complete remission rate of refractory and relapsed NHL patients in low-risk group were significantly higher than those in high-risk group(P<0.01).There were significant differences in regard to the survival resulted from different rescue therapies(P<0.05).Conclusion Increased serum level of CRP and LDH and combined anemia after rescue therapy predicts poor survival for refractory and relapsed NHL patients.